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Busting the myths of controlled crying

"At the end of the day (literally), each family needs to work out what the best technique is to get their infant to sleep" ... Monique Robinson

In my clinical work with pregnant and postnatal mums experiencing anxiety and mood disorders, few issues are reported as consistently as sleep deprivation. Parents who spend the first year of their child’s life (or longer) waking up regularly throughout the night to attend to their child are, not surprisingly, at a higher risk for depression and anxiety.

It’s therefore understandable that parents want to know what can be done to help babies to sleep through the night. And with that interest comes strong opinions, best-selling books and even a “baby whisperer”, as it seems whispering is no longer just for horses.

In the midst of this clamour of advice is a good deal of controversy on a sleep technique for babies known as controlled crying. Advocates claim it saved their baby’s sleep and their sanity. Critics liken it to “normalised abuse” and claim it can cause lasting psychological damage.

We need to start where very few critiques on the topic have started – with a definition of what controlled crying is, and what it is not.

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Controlled crying (also known as controlled comforting) is when parents respond to their infant’s cries and gently comfort them, then return at increasing time intervals to assist the infant to self-settle while knowing that the parent is still there. The key words there are respond and return.

The recommended implementation of such a technique is after six months of age. By Piaget’s theory of object permanence, this is the developmental stage when babies understand that an object (in this case the parent) still exists even when it is out of sight.

Controlled crying is not “extinction”. The extinction method is a dramatically-termed technique which refers to leaving a baby to “cry it out”. For example, when the infant cries at night, the parent shuts the door to the nursery and does not respond at all. The idea is that eventually the baby will understand that the parent is not returning and will self-settle.

In terms of controlled crying (not extinction), Australian researchers found that when mothers of infants aged six to 12 months used one of two interventions (controlled crying and “camping out”, where parents remain in the room while the infant returns to sleep before quietly leaving), not only was there a significant improvement in infants’ sleep, there was also a significant reduction in maternal depressive symptoms compared with controls.

The research team followed up these mothers and infants at the age of six years, and found no difference in emotional or behavioural problems, sleep problems, attachment, parenting styles or maternal mental health between intervention and control groups.

Despite it being clear that extinction techniques were not used in this study, there was considerable controversy about these findings. A letter to the British Medical Journal (BMJ) where the original paper was published even compared the study to research conducted in Nazi Germany under Hitler.

More recently, critics of controlled crying such as Pinky McKay and Margot Sunderland have drawn attention to the long-term ill effects of controlled crying. Ms McKay notes that babies who are left to cry are at risk of sensory deprivation and potentially long-lasting brain damage induced by early trauma, similar to what we know in psychological research as learned helplessness.

These critics are supported by a position paper against the use of controlled crying from the Australian Association for Infant Mental Health (AAIMH); however, this position paper has not been updated in almost ten years and explicitly notes that its reference list does not include any studies on the impact of controlled crying on infants.

The evidence from both animal and human studies is very clear that severe stress such as emotional neglect and abuse in infancy does indeed induce long-lasting changes in the developing brain. And I can see the link between extinction techniques and emotional neglect.

But it’s extreme to compare controlled crying, where the parent responds and returns, to emotional neglect such as that suffered by infants raised in Romanian orphanages. This confusion between extinction and controlled crying appears to be at the heart of the criticisms.

At the end of the day (literally), each family needs to work out what the best technique is to get their infant to sleep. Techniques such as controlled crying and camping out might help some families, but others will be very uncomfortable at the idea of not responding immediately to their infant.

Every baby is different, and suggesting there is one magic solution that will work for all babies, or that what worked for them will work for everyone, is not only misleading, but also confusing and distressing for mothers desperately seeking an answer and some sleep.

There’s a wealth of mums, whisperers, angels, and child health nurses out there – listen to their advice and work out the right solution for you and your family.

Monique Robinson is an Associate Principal Investigator, Telethon Institute for Child Health Research at the University of Western Australia.

This article first appeared on The Conversation.

5 comments so far

Thank you for a thoughtful and well researched article that dispels the ignorant alarmist myths about controlled crying. My husband and I used CC when my son was a few months old. Being his parents, we became adept at distinguishing between a cry of distress and a cry of annoyance. I noticed early on my son often whinged on and off for 5-10 minutes because he was tired or simply didn't feel like napping. He quickly learned to fall asleep on his own.

We still have a bed time routine where we sing songs, cuddle, and whisper silly made up stories. Bed time is a special part of our day and I love bonding with my son during this time. But once I leave his room, he knows it's time to snooze and he doesn't try to jump out of his cot and muck around. CC has been a life saver for us. I had PND and I could not have coped with trying to rock my baby to sleep every day.

Commenter

armum

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June 27, 2013, 1:42PM

Yes, I agree with the previous comment. If you give your baby plenty of loving attention during the day, and learn to distinguish the cries correctly so that you know when there really is a problem and when there is not, then the baby usually learns to settle happily and quickly if left alone to cry a little bit.

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lola

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July 23, 2013, 10:51AM

I resorted to control crying when my little girl was nearly 10 months. I had been working on slowly phasing. Cuddling her until she was nearly asleep then putting her down and patting her off to sleep. This was working ok until I went to visit my parents for 2 weeks, she got sick while we were away and I ended up having her in bed with me at night (because it was so cold in their house and she was sick). She has always cried to get to sleep unless I was nursing her off to sleep (rocking/cuddling etc she would cry). I think that is just her way to falling asleep. We didn't follow the traditional method of controlled crying - we would only allow her to cry for 2 minutes tops before going in, and if she was doing more than grizzling (like armum said the difference between distress and annoyance) we would go in, comfort her until she stopped crying then start again. It was hard, we were close to cracking but we stuck it out and after a week she started sleeping well. She now sleeps sooo well, rarely wakes up before 6am and is so happy waking up it is a delight. I am happier at bed time and we have a happier house.

Commenter

lils

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August 08, 2013, 10:21PM

Our society is obsessed with forcing the independence of sleep on our young when biologically they are designed to sleep close to us, this is normal HUMAN behaviour for millions of years.

The cultural influence of fear of co-sleeping that has been created over the past 200 years has forced methods for babies to sleep alone or self settle is the term so over used and there is no understanding that babies brains and by nature are not designed to be left "in cave to sleep independently"

I think its rather dismissive and naive to say there is no harm, especially since The Murdoch Institute Report has never been peer reviewed, the emotional/mental health feedback was given by the parents of the children in the study, it was not independently assessed, and six years old is not regarded as longer term. Everyone seems to be obsessed with "it works" but how it works is the grossly misunderstood part.

What about the negatives with controlled crying? The clinginess, the vomiting, head banging cots, loss of voice from screaming, the night terrors – were these all attributed to “normal development”? and there has NEVER been a study to explain how long its actually safe to leave a baby to cry.

If co-sleeping was not so demonized there would be less post natal depression and a management of expectation about motherhood. Especially the first years?

For Margot Sunderland Head of Children's Mental Health in the UK and author of The Science of Parenting to be concerned about sleep training is something not to be flippant about.

Parents need to listen to their instincts because no way in the world would I be sitting outside my 8mth olds room for up to 20minutes listening to them cry for the sake of sleep.

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